For those of us with chronic illnesses, “how are you?” is one of the most difficult questions to answer. For most people, in most circumstances, this is simply a polite way of starting a conversation, and the stock answer “I’m fine, how are you?” will normally suffice. (Even my son’s girlfriend’s daughter, not yet two, has picked up on this!)

But there are times when this simply won’t do. The extreme case is perhaps the story about the man who goes to see the doctor; the doctor asks “How are you?” and he replies “Fine”, so the doctor says, “Good. Next patient!”

If people ask “how are you?” and you reply “fine” when you’re not, this is not authentic communication. Yet the other extreme, to respond with a full list of all today’s symptoms, is generally not helpful either.

The trick is to know, when someone asks “how are you?”, just how much they really want to know, and whether a reply of “I’m fine”, or perhaps more honestly “not too bad”, is enough, or whether something more specific is required. The trouble is that this takes up some brain energy, which could perhaps be better spent in doing something useful, like keeping you awake.

When people know you’re not well, however, the question “are you feeling better?” can sometimes be even trickier. For example, because my ME is on the mild/moderate end of the spectrum, I can usually get out now and then, and will generally try to attend church on a Sunday even if that’s the only thing I’ve managed to do. So I suspect that for some people I really do have an invisible illness, as they only see me where they would expect to see me anyway. But on the occasions when I’m not up to going, and my family members have to explain I’m not feeling well, then going back the next week is when I get the question “are you feeling better?”.

Better than what? Better than last week, almost certainly, otherwise I probably wouldn’t be there. But not better in general, like someone getting over the flu who has now returned to full health. “Are you better?” often means “are you well, now?”

Even for those who know about my illness, and really care about how I’m feeling today, or how I’ve been over the last week or so, it can be a tricky conversation. And I need to recognise that it’s tricky for both of us. What would I ask someone who I know to be chronically ill, when I meet them?

The same kind of dilemma applies when we try to be encouraging to those who suffer like this, especially when we know that they are a bit worse today than they usually are. Do we say “get well soon”, or “hope you’re feeling better tomorrow”? Of course we would like people to get well completely, but if we know something about their condition we recognise that it’s unlikely to happen overnight. Or, if they’re suffering from one especially severe symptom on a particular day, do we simply wish for that to clear up, leaving them with their other symptoms?

This is something that I’m currently trying to get to grips with as I explore Twitter and am in contact with other sufferers. When someone tweets that they’re having a bad day, how can I respond in a way that is encouraging and hopeful but not overoptimistic?

So I do what I can, and apologise for all the times I get it wrong. And how am I? Well, today I managed to do the food shopping, but was much more tired than I usually am afterwards; on the plus side, so far today I haven’t had any of the dizzy spells which have been plaguing me most of the week.